Growth and Development

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Pediatric Growth and Development

GROWTH AND DEVELOPMENT

INFANT TO ADOLESCENT GROWTH AND DEVELOPMENT

Growth and development begin with birth. As infants and children grow and mature, they pass through predictable stages of development. Knowledge and assessment of growth and development help the nurse provide screening for physical and emotional problems; offer anticipatory guidance to parents and caregivers; develop a rapport with the child to enhance the provision of health care; and provide education to the family to build a healthy lifestyle for the future.

Infant to Adolescent Growth and DevelopmentAGE AND PHYSICAL CHARACTERISTICS

BEHAVIOR PATTERNS NURSING CONSIDERATIONS

Birth-4 Weeks (1 Month) Significant neurologic

disorganization. Strong Moro reflex. Sleep cycle

disorganized.

GI system too immature for solid foods.

Motor development Momentary visual fixation

on objects and adult face. Eyes follow bright moving

objects. Lies awake on back. Immediately drops objects

placed in hands. Responds to sounds of bell

and other similar noises. Keeps hands fisted.

Socialization and vocalization Mews and makes throaty

noises. Shows interest in human

face.

Cognitive and emotional development

Reflexive. External stimuli are

meaningless. Responses are generally

limited to tension states or discomfort.

Gains satisfaction from feeding and being held, rocked, fondled, and cuddled.

Has an intense need for sucking pleasure.

Quiets when picked up.

Play stimulation Use human face smile and

talk. Dangle bright and moving

object (e.g., mobile) in field of vision.

Hold, touch, caress, fondle, and kiss.

Rock, pat, change position. Play soft music or have infant

listen to ticking clock, sing. Talk to infant, call by name.

Parental guidance Begin to expose infant to

different household sounds. Change crib location in room. Use bright-colored clothing

and linen. Put infant to sleep on back

until old enough to roll. Keep infant nearby. Play with infant when awake. Hold during feeding.

NURSING ALERT Educate parents about infant sleep stages and putting infant to sleep on back.

4-8 Weeks (2 Months) Crossed extensor reflex

disappears.

Tonic neck reflex begins to fade.

Motor development Reflexive behavior is

slowly being replaced by voluntary movements.

Turns from side to back. Begins to lift head

momentarily from prone position.

Shows eye coordination to light and objects.

If bell is sounded nearby, infant will stop activity and listen.

Eyes follow better, both

Play stimulation Arrange mobile over crib so

infant's movement will set it in motion.

Hang wind chimes near infant.

Hang bright-colored pictures on wall (yellow and red-colored stripes, for example).

Use cradle gym and infant seat.

Use rattles. Hold infant and walk around

room.

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vertically and horizontally. Focuses well.

Socialization and vocalization Begins vocalization, coos,

especially to a voice. Crying becomes

differentiated. Visually looks for sounds. May squeal with delight

when stimulated by touching, talking, or singing.

Begins social smile. Eyes follow person or

object more intently.


Recognizes familiar face. Becomes more aware and

interested in environment. Anticipates being fed when

in feeding position.

Enjoys sucking, puts hand in mouth.

Allow freedom of kicking with clothes off.

Parental guidance Talk to infant and smile; get

excited when infant coos. Place infant seat on a secure

surface (e.g., floor, center of a table, never near edge of table) near mother's activities.

Put infant in prone position in bed or on floor.

Expose infant to different textures.

Exercise infant's arms and legs.

Sing to infant.

Provide tactile experience during bathing, diapering, and feeding.

8-12 Weeks (2-3 Months) Landau reflex appears

at 3-4 months. Positive support reflex

disappears. Posterior fontanelle

closes.

Increases in body fluid, real tears appear, drooling, and GI juices increase.

Motor development When prone, will rest on

forearms and keep head in midline, makes crawling movements with legs, arches back, and holds head high; may get chest off surface.

Indicates preference for prone or supine.

Discovers hands, bats objects with hands.

Holds objects in hands and brings to mouth.

Has fairly good head control.

Socialization and vocalization Smiles more readily,

babbles and coos. Stops crying when mother

enters room or when caressed.

Enjoys playing during feeding.

Stays awake longer without crying.

Turns head to follow familiar person.


Shows active interest in environment.

Recognizes familiar faces and objects.

Focuses and follows objects.

Play stimulation Encourage socialization,

smiling, and laughing. Place on mat on floor. Continue to introduce new

sounds.

Parental guidance Take outdoors with proper

clothing (similar warmth as that of adults), hat, and PABA-free sunscreen.

Bounce on bed. Play with infant during

feeding. Rattles can be used

effectively for visual following and for hand play.

Encourage older siblings to make faces, sing, and talk to infant.

NURSING ALERT Children of all ages should avoid intense sun exposure, particularly during the middle of the day. PABA-free sunscreen with a sun protection factor of at least 15 should be used on children of all ages, particularly if sun exposure is longer than 30 minutes.

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Shows repetitiveness in play activity.

Is aware of strange situations.

Derives pleasure from sucking, purposefully gets hand to mouth.

Begins to establish routine preceding sleep.

12-16 Weeks (3-4 Months) Moro reflex fades. Stepping reflex

disappears. Rooting reflex

disappears. By 4-5 months infant's

weight approximately doubles birth weight.

Average weekly weight gain, 4-7 ounces (113.5-198.5 g).

Average monthly height gain, 1 inch (2.5 cm).

Pulse rate slows to 100-140 beats/minute.

Respirations, 20-40 breaths/minute.

Grasp becomes voluntary.

Sucking becomes voluntary.

Motor development Eyes focus on small

objects, may pick a dangling ring.

Holds head up (when being pulled to sitting position).

Becomes more interested in environment.

Hand comes to meet rattle. Listens, turns head to

familiar sound. Sits with minimal support. Intentional rolling over,

back to side. Reaches for offered objects. Grasps objects with both

hands, and everything goes into mouth.

Socialization and vocalization Laughs and chuckles

socially. Demands social attention

by fussing. Recognizes mother. Begins to respond to No,

no. Enjoys being propped in

sitting position.


Actively interested in environment.

Enjoys attention; becomes bored when alone for long periods.

Recognizes bottle. More interested in mother. Indicates increasing trust

and security.

Sleeps through night; has defined nap time.

Play stimulation Encourage mirror play. Provide soft squeeze toys in

vivid colors of varying texture.

Allow infant to splash in bath. Infant still enjoys holding and

playing with rattles. Enjoys old-fashioned

clothespins and playing pat-a-cake and peek-a-boo.

Parental guidance Be certain button eyes on toys

and other small objects cannot be pulled off.

Hold rattle and let infant reach and grasp it.

When infant is in high chair, strap in.

Move mobile out of reach infant may grab it and cause injury.

Repeat child's sounds. Talk in varying degrees of

loudness. Begin looking at and naming

pictures in book. Begin roughhousing play by

both parents.

Give space in playpen or on sheet on floor to practice rolling over.

16-26 Weeks (4-7 Months) By 5-6 months, tonic

neck reflex disappears. By 6-7 months, palmar

grasp disappears. By 7-9 months,

develops eye-to-eye contact while talking; engages in social games.

Two central lower

Motor development Shows momentary sitting

with hand support. Bounces and bears some

weight when held in standing position.

Transfers and mouths objects in one hand.

Discovers feet. Bangs objects together. Rolls over well.

Play stimulation Enjoys social games, hide-

and-seek with adult, toys, and large blocks.

Likes to bang objects. Plays in bounce chair and

walker. Enjoys large nesting toys

(round rather than square). Likes to drop and retrieve

things.

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incisors erupt. Spine C-shaped, lacks

lordotic and lumbar curves.

Eustachian tube short and horizontal, which may be a factor in ear infections.

GI system matures enough for solid foods.

May begin some form of mobility.

Socialization and vocalization Discriminates between

strangers and familiar people.

Crows and squeals. Starts to say “Ma, Da.” Play is self-contained. Laughs out loud. Makes talking sounds in

response to others' talking. Begins fear of strangers,

8½-10 months


Secures objects by pulling on string.

Searches for lost objects that are out of sight.

Inspects objects; localizes sounds.

Likes to sit in high chair. Drops and picks up objects. Displays exploratory

behavior with food. Exhibits beginning fear of

strangers. Becomes fretful when

mother leaves.

Shows much mouthing and biting.

Likes metal cups, wooden spoons, and things to bang with.

Loves crumpled paper. Enjoys squeeze toys in bath. Likes peek-a-boo, bye-bye,

and pat-a-cake.

Parental guidance Will play as long as you can. Tie toys to chair with short

string. Let play with extra spoon at

feeding. Give soft finger foods. Because infant puts

everything in mouth, use safety precautions.

Keep small items away from infant; could choke on them.

Show excitement at achievements.

Supply safe kitchen items for toys.

26-40 Weeks (7-10 Months) Four upper incisors

erupt around 7-9 months.

By 9-12 months, plantar reflex disappears.

By 9-12 months, neck-righting reflex disappears.

6-12 months Average weekly weight

gain, 3-5 ounces (85-141.7 g).

Average monthly height gain, ½ inch (1.25 cm).

Motor development Sits without support. Recovers balance. Manipulates objects with

hands. Unwraps objects. Creeps. Pulls self upright at crib

rails. Uses index finger and

thumb to hold objects. Rings a bell. Can feed self a cracker and

can hold a bottle. Chewing reflex develops.

Can control lips around cup.

Does not like supine position.

Can hold index finger and thumb in opposition.

Socialization and vocalization Claps hands on request. Responds to own name. Is very aware of social

environment. Imitates gestures, facial

expressions, and sounds. Smiles at image in mirror. Offers toy to adult, but does

Play stimulation Encourage use of motion toys,

rocking horse and stroller. Water play. Imitate animal sounds. Allow exploration outdoors. Provide for learning by

imitation. Offer new objects (blocks). Child likes freedom of

creeping and walking, but closeness of family is important.

Good toys: plastic milk carton; bean bag for tossing; fabric books; things to move around, fill up, empty out; pile-up and knock-down toys.

Parental guidance Protect from dangerous

objects, cover electrical outlets, block stairs, remove breakable objects from tables.

Have child with family at mealtime.

Offer cup.

Talk and sing to infant.

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not release it. Begins to test parental

reaction during feeding and at bedtime.

Will entertain self for long periods.


Begins to imitate. Shows more interest in

picture books. Enjoys achievements.

Has strong urge toward independence, locomotion, feeding, dressing.

10-12 Months (1 Year) Develops lordotic and

lumbar curves to make walking possible.

By 12-24 months, Landau reflex disappears.

Weight should approximately triple birth weight.

Two lower lateral incisors appear.

Four first molars appear by 14 months.

Child development theories Freudian: Behavior

Birth-1 year Oral Stage Eriksonian:

Emotion/PersonalityBirth-1 year Sense of Trust vs. Mistrust

Piagetian: Intellectual Activity (Thought Process)Birth-2 years Sensorimotor Period

Motor development Cruises around furniture. Beginning to stand alone

and toddle. Turns pages in book. Tries tossing object. Shows hand dominance. Navigates stairs; climbs on

chairs. Builds a tower of 2 blocks. Puts balls in box. May use spoon. Can release objects at will. Has regular bowel

movements.

Socialization and vocalization Uses jargon. Points to indicate wants. Loves give-and-take game. Responds to music. Enjoys being center of

attention and will repeat laughed-at activities.


Shows fear, anger, affection, jealousy, anxiety, and sympathy.

Experiments to reach new goals.

Displays intense determination to remove barriers to action.

Begins to develop concepts of space, time, and causality.

Has increased attention span.

Play stimulation Ball play. Cloth doll. Motion objects and toys. Transporting objects. Name and point to body parts. Put-in and take-out toys. Sand box with spoons and

other simple objects. Blocks. Music.

Parental guidance Allow self-directed play

rather than adult-directed play.

Continue to expose to foods of different textures, taste, smell, and substance.

Offer cup. Show affection and encourage

child to return affection.

Safety teaching: Child gets into everything within reach. Place medications in safe, locked place. Create a safe environment for child. Use stair guards, faucet protectors, and drawer locks. Have Poison Control Center phone number on hand.

12-18 Months Note: Between ages 1

and 3 years the child is called a toddler.

Anterior fontanelle closes.

Abdomen protrudes,

Motor development Walks up stairs with help,

creeps downstairs. Walks without support and

with balance. Falls less frequently. Throws ball.

Play stimulation Allow unrestricted motor

activity (within safety limits). Offer push-pull toys. Child selects favorite toy. Child likes blocks, pyramid

toys, teddy bears, dolls, pots

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arms and legs lengthen. Big muscles become

well developed. Four cuspids appear by

18 months. Fine muscle

coordination begins to develop.

Average yearly weight gain, 4½-6½ (2-3 kg).

Average height gain during second year, 4¾ inch (12 cm).

Stoops to pick up toys, look at bug.

Turns pages of book. Holds and lifts cup. Builds 3-block tower. Picks up and places small

beads in container. Begins to use spoon.


Has vocabulary of 10 words that have meanings.

Uses phrases, imitates words.

Points to objects named by adult.

Follows directions and requests.

Imitates adult behavior. Retrieves toy from several

hiding places.

Psychosocial development Develops new awareness of

strangers. Wants to explore

everything in reach. Plays alone, but near others. Is dependent on parents, but

begins to reach out for autonomy.

Finds security in a blanket, toy, or thumb sucking.

and pans, cloth picture books with colorful large pictures, telephone, musical top, and nested blocks.

Parental guidance Begin to teach tooth brushing

to establish good dental habits; however, continue to brush child's teeth.

Establish limits to give toddler sense of security, but encourage exploration.

Reinforce safety teaching.

1½-2 Years Protruding abdomen

less noticeable. Landau reflex

disappears. During first 2 years, 14

inches (35 cm) are added to height.

Slight bowing of legs with a wide-based walk.

Handedness may become apparent.

Motor development Walks up and down stairs. Opens doors; turns knobs. Has steady gait. Holds drinking cup well

with one hand. Uses spoon without spilling

food (may prefer fingers). Kicks a ball in front of him

without support. Builds a tower of 4-6

blocks. Scribbles. Rides tricycle or kiddie car

(without pedals).

Cognitive development Has 200-300 words in

vocabulary. Begins to use short

sentences. Refers to self by pronoun. Obeys simple commands. Does not know right from

wrong. Begins to learn about time

sequences.

Play stimulation Shows parallel play, although

enjoys having other children around.

Has very short attention span. Enjoys same toys as child of

18 months. Likes doll play and balls. Imitates parents in domestic

activities. Likes swing, hammering,

paper, and large crayons.

Parental guidance Has need for peer

companionship, although displays immaturity by inability to share and take turns.

A decrease in appetite normally occurs at this stage.

Toilet training should be started (each child follows own pattern).

Begin to have child eat meals with family if not already doing so.

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Psychosocial development Uses word “mine”

constantly. Is possessive with toys. Displays negativism, uses

“no” as assertion of self. Routine and rituals are

important. May begin cooperation in

toilet training. Resists restrictions on

freedom. Has fear of parents' leaving. Shows parallel play. Dawdles. Resists bedtime, uses

transitional objects (blanket, toy).

Vacillates between dependence and independence.

Begin to read to child; child likes storybooks with large pictures.

2-3 Years Height approximates

one-half adult height. Legs are about 34% of

body length. Begins 5 lb (2.3 kg) or

more weight gain per year until age 5 years.

At 2Â½ years has full set (20) of baby teeth.

Four second molars appear by 2½ years.

Height gain, 23/8-3¼ inches (6-8 cm).

Lordosis and protuberant abdomen of toddler disappear.

Child development theories Freudian:

1-3 years Anal Stage Eriksonian:

1-3 years Sense of Autonomy vs. Shame and Doubt

Piagetian:2-7 years Preoperational Period; shows egocentrism and centering

Motor development Throws objects overhead. Pedals tricycle. Walks backward. Washes and dries hands. Begins to use scissors. Can string large beads. Can undress himself. Feeds himself well. Tries to dance. Jumps in place. Builds tower of 8 blocks. Balances on one foot. Swings and climbs. Can eat an ice cream cone. Drinks from a straw. Chews gum without

swallowing it.

Cognitive development Shows increased attention

span. Gives first and last name. Begins to ask “why” Is egocentric in thought and

behavior. Beginning ability to reflect

on own behavior. Talks in short sentences. Uses plurals. May attempt to sing simple

songs. Has vocabulary of 900

words. Begins fantasy. Begins to understand what

it means to take turns. Can repeat three numbers. Shows interest in colors.

Psychosocial development Negativism grows out of

child's sense of developing

Play stimulation Plays simple games with

other children. Enjoys story-telling and

dress-up play. Plays “house” Colors. Uses scissors and paper. Rides tricycle. Read simple books to child. Will assist in developing

memory skills, visual discrimination skills, and language.

Parental guidance From 2-3 years, the child

develops a seeming maturity; do not expect more than child is able to do.

Arrange first visit to the dentist to have teeth checked.

Be aware that negativistic and ritualistic behavior is normal.

Be consistent in discipline. Control temper tantrums. Begin to teach traffic safety.

Supervise outdoor play.

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independence says “no” to every command.

Ritualism is important to toddler for security (follows certain pattern, especially at bedtime).

Temper tantrums may result from toddler's frustration in wanting to do everything for self.

Shows parallel play as well as beginning interaction with others.

Engages in associative play. Fears become pronounced. Continues to react to

separation from parents but shows increasing ability to handle short periods of separation.

Has daytime bladder control and is beginning to develop nighttime bladder control.

Becomes more independent.

Begins to identify sex (gender) roles.

Explores environment outside the home.

Can create different ways of getting desired outcome.

3-4 Years Note: Between ages 3

and 5 years, the child is called a “preschooler.”

May appear “knock kneed.”

Motor development Drawings have form and

meaning, not detail. Copies a circle and a cross. Buttons front and side of

clothes. Laces shoes. Bathes self, but needs

direction. Brushes teeth. Shows continuous

movement going up and down stairs.

Climbs and jumps well. Attempts to print letters.

Cognitive development Awareness of body is more

stable; child becomes more aware of own vulnerability.

Is less negativistic. Learns some number

concepts. Begins naming colors. Can identify longer of two

lines. Has vocabulary of 1,500

words. Uses mild profanities and

name-calling. Uses language aggressively. Asks many questions.

Play stimulation Plays and interacts with other

children. Shows creativity. Likes ring-around-the rosy. Helps adults. Likes costumes and enjoys

dramatic play. Toys and games: record

player, nursery rhymes, housekeeping toys, transportation toys (tricycle, trucks, cars, wagon), blocks, hammer and peg bench, floor trains, blackboard and chalk, easel and brushes, clay, crayon and finger paints, outside toys (sandbox, swing, small slide), books (short stories, action stories), drum, scrapbook.

Parental guidance Base your expectations within

child's limitations. Provide limited frustrations

from environment to assist in coping.

Give small tasks to do around the house (putting silverware on table, drying a dish).

Expand child's world with

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May not be abstract enough to understand body parts that cannot be seen or felt.

Can be given simple explanation as to cause and effect.

Thinks very concretely; demonstrates irreversibility of thought.

Immature concept of death, believes it is reversible.

Has beginning understanding of past and future.

Is egocentric in thought.

Psychosocial development Is more active with peers

and engages in cooperative play.

Performs simple tasks. Frequently has imaginary

companion. Dramatizes experiences. Is proud of

accomplishments. Exaggerates, boasts, and

tattles on others. Can tolerate separation

from mother longer without feeling anxiety.

Is keen observer. Has good sense of “mine”

and “yours.” Behavior still frequently

ritualistic.

Becomes curious about life and sex. Often indulges in masturbation.

trips to the zoo, to the supermarket, to restaurant, etc.

Prevent accidents. Provide for brief

nonthreatening separation from parents and home.

Reinforce correct use of language.

Use opportunities for simple sexual education as child's needs arise.

Accept masturbation as a normal phenomenon to be discouraged in public.

Provide consistent discipline, motivated by love rather than anger.

Consider nursery school.

4-5 Years By 2-5 years adds 9½

inches (25 cm) to height.

At age 4, legs comprise about 44% of body length.


3-6 years Phallic Stage Eriksonian:

3-6 years Sense of Initiative vs. Guilt

Piagetian:2-7 years Preoperational Period; shows egocentrism and centering

Motor development Hops two or more times. Dresses without

supervision. Has good motor control,

climbs and jumps well. Walks up stairs without

grasping handrail. Walks backward. Washes self without

wetting clothes. Prints first name and other

words. Adds three or more details

in drawings. Draws a square.

Cognitive development Has 2,100-word

vocabulary. Talks constantly. Uses adult speech forms. Participates in

conversations. Asks for definitions.

Play stimulation Demonstrates gross motor

activity likes to jump rope, skip, climb on jungle gyms, etc.

Prefers group play and cooperates in projects.

Plays simple letter, number, form, and picture games.

Plays with cars and trucks. Still likes being read to. Continues to enjoy fantasy

play.

Parental guidance Child no longer takes an

afternoon nap. Prepare child for

kindergarten. Tell him stories. Provide opportunities and

reassurance for group play; have his friends visit for lunch and an afternoon of playing.

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Knows age and residence. Identifies heavier of two

objects. Knows weeks as time units. Names days of week. Begins to understand

kinship. Knows primary colors. Can count to 10. Can copy a triangle. Has high degree of

imagination. Questioning is at a peak. Begins to develop power of

reasoning.

Psychosocial development May have an imaginary

companion. Has a sense of order (likes

to finish what was started). Is obedient and reliable. Is protective toward

younger children. Begins to develop an

elementary conscience with some influence in governing behavior.

Has increased self-confidence.

Accepts responsibility for acts.

Is less rebellious. Has dreams and nightmares. Is cooperative and

sympathetic. Shows generosity with toys. Begins to question parents'

thinking.

Identifies strongly with parent of same sex.

Prevent accidents.

Encourage child's participation in household activities.

Middle Childhood (5-9 Years)

Growth rate is slow and steady.

Gains an average of 7 lb (3.2 kg) per year. Height increases approximately 2½ inch (6.3 cm) per year.

Among children there is considerable variation in height and weight.

Appears taller and slimmer.

Early lordosis disappears.

Begins to lose baby teeth; permanent teeth appear at a rate of about 4 teeth per year from 7-14 years.

Neuromuscular and skeletal development

Motor development6 years

Is active and impulsive. Balance improves. Uses hands as manipulative

tools in cutting, pasting, hammering.

Can draw large letters or figures.

7 years Has lower activity level. Capable of fine hand

movements; can print sentences.

Nervous habits, such as nail biting, are common.

Muscular skills, such as ball throwing, have improved.

8 years Moves with less

restlessness.

Parental guidance Family atmosphere continues

to have an impact on the child's emotional development and future response within the family.

The child needs ongoing guidance in an open, inviting atmosphere. Limits should be set with conviction. Deal with only one incident at a time. When punishment is necessary, the child should not be humiliated. Child should know that it was the act that the adult found undesirable, not the child.

Needs assistance in adjusting to new experiences and demands of school. Should be able to share experiences with family. Parents need to have communication with the

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allows improved coordination.

Eyes become fully developed; vision approaches 20/20.

Handedness should be well developed.


(5-9 years) Beginning of Latency Period

Eriksonian:(5-9 years) Industry vs. Inferiority

Piagetian:(5-9 years) Enters Stage of Concrete Operations

Has developed grace and balance, even in active sports.

Has developed coordination of fine muscles, allowing child to write in script.

9 years Uses both hands

independently. Has become skillful in

manual activities because of improved eye-hand coordination.

Cognitive development6 years

Begins to learn to read. Defines objects in terms of use. Time sense is as much in past as present.

Is interested in relationship between home and neighborhood; knows some streets.

Uses sentences well; uses language to share others' experiences; may swear or use slang.

Distinguishes morning from afternoon.

7 years More reflective and has

deeper understanding of meanings.

Interested in conclusions and logical endings. Begins to have scientific interests in cause and effect.

More responsible in relation to time, is more punctual. Sense of space is more realistic; child wants some space of own.

Knows value of coins. Concept of death maturing,

includes idea of irreversibility.

8 years Thinking is less animistic.

Is aware of impersonal forces of nature. Begins to understand logical reasoning, conclusions, and implications.

Less self-centered in thinking. Personal space is expanding; goes places on own. Aware of time; plans events of day. Understands right from left.

9 years

teacher to work together for the health of the child.

Convey love and caring in communication. The child understands language directed at feelings better than at intellect. Get down to eye level with the child.

Focus attention on child's abilities and accomplishments rather than shortcomings and limitations.

The child is sex-conscious and should be able to discuss questions at home rather than with friends. Requires simple, honest answers to questions.

Common problems include teasing, quarreling, nail biting, enuresis, whining, poor manners, swearing, lying, cheating, and stealing. These are usually fleeting phases and should not be handled negatively. The causes for such behavior should be investigated and dealt with constructively.

The child needs order and consistency to help in coping with doubts, fears, unacceptable impulses, and unfamiliar experiences.

Encourage peer activities as well as home responsibilities and give recognition to child's accomplishments and unique talents.

Television may stimulate learning in several spheres, but should be monitored.

Accidents are a major cause of disability and death. Safety practices should be continued. (Refer to section on safety, page 1357).

Exercise is essential to promote motor and psychosocial development. The child should have a safe place to play and simple pieces of equipment.

A school health program should be available and concerned with the child's physical, emotional, mental, and social health. This should be augmented by information and example at home.

Medical supervision should continue with yearly examination to detect developmental delay and disease. Appropriate immunizations should be

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Intellectually energetic and curious. Realistic; reasonable in thinking. Able to plan in advance. Breaks complex activities into steps.

Focuses on detail. Sense of space includes the

entire earth. Participates in family

discussions. Likes to have secrets.

Psychosocial development5-9 years

Still requires parental support, but pulls away from overt signs of affection.

Peer groups provide companionship in widening circle of persons outside the home. Child learns more about self as he learns about others.

Chum stage occurs at about age 9 or 10. Child chooses a special friend of same sex and age in whom to confide. This is usually child's first love relationship outside of home, when someone becomes as important to him as himself.

Play teaches the child new ideas and independence. Child progressively uses tools of competition, compromise, cooperation, and beginning collaboration.

Body image and self-concept are fluid because of rapid physical, emotional, and social changes.

Latency-stage sexual drive is controlled and repressed. Emphasis is on the development of skills and talent.

Patterns of play6-7 years

Child acts out ideas of family and occupational groups with which he has contact.

Painting, pasting, reading, simple games, watching television, digging, running games, skating, riding bicycle, and swimming are all enjoyed activities.

administered. The child frequently has quiet

days periods of shyness, which should be tolerated as part of growing up and deciding who he or she is.

The child may be subject to nightmares, a situation that requires reassurance and understanding.

Parents, teachers, and health professionals should be available and able to provide information and answer questions about the physical changes that occur.

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8 years Child enjoys collections;

loosely formed short-lived clubs; table games; card games; books; television; and records.

Late Childhood (9-12 Years) Vital signs approach

adult values. Loses childish

appearance of face and takes on features that will characterize individual as an adult.

Growth spurt occurs, and some secondary sex characteristics appear: in girls, between ages 10 and 12 years; in boys, between ages 12 and 14 years.

Increased height and weight, increased perspiration and activity of sebaceous glands; vasomotor instability; increased fat deposition.

Physical changes in girls: Pelvis increases in

transverse diameter; hips broaden; tenderness in developing breast tissue; enlargement of areola diameter; appearance of pubic hair.

Physical changes in boys: Size of testes increases;

scrotum color changes; breasts enlarge, temporarily; height and shoulder breadth increase.

Appearance of lightly pigmented hair at base of penis.

Increase in length and width of penis.


9-12 years - Latency Period continues

Eriksonian:9-12 years - Industry vs. Inferiority continues

Piagetian:9-12 years - Stage of Concrete Operations continues

Motor development Energetic, restless, active

movements such as finger-drumming or foot-tapping appear.

Has a skillful manipulative movement nearly equal to those of adults.

Works hard to perfect physical skills.

Cognitive development10 years

Likes to reason, enjoys learning.

Thinking is concrete, matter of fact.

Wants to measure up to challenge.

Likes to memorize, identify facts.

Attention span may be short. Space is rather specific (i.e., where things are).

Can write for relatively long time with speed.

11 years Likes action in learning. Concentrates well when

working competitively. Can understand relational

terms, such as weight and size.

Perceives space as nothingness that goes on forever.

Can discuss problems. Can conceptualize

symbolically enough to understand body parts.

Can describe some abstract terms.

12 years Enjoys learning. Considers all aspects of a

situation. Motivated more by inner

drive than by competition. Able to classify, arrange,

and generalize. Likes to discuss and debate. Begins conceptual thinking. Verbal, formal reasoning

now possible. Can recognize moral of a

story.

Parental guidance Continue appropriate

interventions related to early childhood.

Continue sex education and preparation for adolescent body changes.

Understanding is important. Encourage participation in

organized clubs and youth groups.

Democratic guidance is essential as child works through a conflict between dependence (on parents) and independence. The child needs realistic limits set.

Needs help channeling energy in proper direction, work and sports.

Requires adequate explanation of body changes. Special understanding is required for the child who lags in physical development.

Continue consistent disciplinary style.

14

Defines time as duration; likes to plan ahead.

Understands that space is abstract.

Can be critical of own work.

Psychosocial development Gang becomes important,

and gang code takes precedence over nearly everything. Gang codes are typically characterized by collective action against the mores of the adult world. Here, children begin to work out their own social patterns without adult interference. Early gangs may include both sexes; later gangs are separated by sex.

May strive for unreasonable independence from adult control.

Usually interested in religion and morality.

Has increased interest in sexuality.

May reach puberty; resurgence of sexual drives causes recapitulation of Oedipal struggle.

Patterns of play Continues to enjoy reading,

TV, and table games. More interested in active

sports as a means to improve skills.

Creative talents may appear; may enjoy drawing, and modeling clay. By age 10, sex differences in play become profound.

Occasional privacy is important.

Begins to have vocational aspirations.

Early Adolescence (12-14 Years)

Phase of development begins when reproductive organs become functionally operative; phase ends when physical growth is completed.

Skeletal system grows faster than supporting muscles.

Hands and feet grow proportionately faster than rest of body.

Motor development Usually uncoordinated; has

poor posture. Tires easily.

Cognitive development Mind has great ability to

acquire and use knowledge. Abstract thinking is

sufficient to learn multivariable ideas such as the influence of hormones on emotions.

Categorizes thoughts into usable forms.

Parental guidance Stresses frequently result

from conflicting value systems between generations. The parents may need help to see that the adolescent is a product of the times and that actions reflect what is happening around the youngster.

The parents' limits and rules should be realistic and consistent. They should convey the parent's love and concern and should be a

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Large muscles develop more quickly than small muscles.

Girls: Physical changes

include beginning of menarche; growth of axillary and perineal hair; deepened voice; ovulation; further development of breasts.

Nutritional need for iron and calcium increase dramatically.

Boys: Physical changes

include growth of axillary, perineal, facial, chest hair; deepening of voice; production of spermatozoa; nocturnal emissions.


(12-14 years)Begins Stage of Sexuality

Eriksonian:(12-14 years) Identity vs. Role Diffusion

Piagetian:(12-14 years) Begins Stage of Formal Operations

May project thinking into the future.

Is capable of highly imaginative thinking.

Psychosocial development Interest in opposite sex

increases. Often revolts from adult

authority to conform to peer-group standards.

Continues to rework feelings for parent of opposite sex and unravel the ambivalence toward parent of same sex.

Affection may turn temporarily to an adult outside of the family (for example, crush on family friend, neighbor, or teacher).

Uses peer-group dialect, highly informal language or specially coined terminology.

Peer groups are especially important and help adolescent to define own identity, to adapt to changing body image, to establish more mature relationships with others, and to deal with heightened sexual feelings. Cliques may develop.

Dating generally progresses from groups of couples to double dates and finally single couples.

Teenage “hangouts” become important centers of activity.

Begins questioning existing moral values.

source of comfort and reassurance, protecting the child from activities for which he is not ready.

The home should be an accepting, emotionally stable environment.

Continue sex education, including discussion of ovulation, fertilization, menstruation, pregnancy, contraception, masturbation, nocturnal emissions, and hygiene.

Adolescents have an increased need for rest and sleep because they are expending large amounts of energy and are functioning with an inadequate oxygen supply.

Recreational interests should be fostered. Favorite activities include sports, dating, dancing, reading, hobbies, and television. Socializing via telephone or computer and listening to music are favorite pastimes.

Adolescent health problems that require preventive education are accidents, obesity, acne, pregnancy, sexually transmitted disease, and drug abuse.

Allow the adolescent to handle his own affairs as much as possible, but be aware of physical and psychosocial problems that may require help. Encourage independence but allow the child to lean on the parents for support when frightened or unable to attain goals.

Adolescents with special problems should have access to specialists, such as adolescent clinics and psychologists.

Requires reassurance and help in accepting a changing body image. Parents should make the most of the child's positive qualities.

Give gentle encouragement and guidance regarding dating. Avoid strong pressures in either direction.

Understand conflicts as the child attempts to deal with social, moral, and intellectual issues.

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DEVELOPMENTAL SCREENING- Assessment tools have been created to determine the overall developmental age of a child or to detect

specific areas of development that are lacking. The most widely used developmental screening tool is the Denver II Developmental Screening Test (Denver II). This tool provides for a quick overview of development in children from birth to age 6 years and identifies areas of strength and weakness relative to age norms.

- Another method for developmental screening involves interviewing the parent or caregiver about attainment of developmental milestones. Persistent deficits or deficits in multiple areas indicate a more serious problem than deficits in a single area.

Developmental MilestonesA method of evaluation has been developed using an interview technique in which parents are asked questions regarding milestones in achievements that most will remember. The child's developmental quotient (DQ) can be determined according to the parents' answers. A DQ less than 70% signifies a delay requiring further evaluation.AGE GROSS

MOTORVISUAL-MOTOR/PROBLEM-SOLVING

LANGUAGE SOCIAL/ADAPTIVE

1 month

Raises head slightly from prone, makes crawling movements

Birth: visually fixes 1 mo: has tight grasp, follows to midline

Alerts to sound Regards face

2 month

Holds head in midline, lifts chest off table

No longer clenches fist tightly, follows object past midline

Smiles socially (after being stroked or talked to)

Recognizes parent

3 month

Supports on forearms in prone, holds head up steadily

Holds hands open at rest, follows in circular fashion, responds to visual threat

Coos (produces long vowel sounds in musical fashion)

Reaches for familiar people or objects, anticipates feeding

4 month

Rolls front to back, supports on wrists and shifts weight

Reaches with arms in unison, brings hands to midline

Laughs, orients to voice Enjoys looking around environment

5 month

Rolls back to front, sits supported

Transfers objects Says ah-goo, blows raspberries, orients to bell (localizes laterally)

6 month

Sits unsupported, puts feet in mouth in supine position

Unilateral reach, uses raking grasp

Babbles Recognizes strangers

7 month

Creeps Orients to bell (localized indirectly)

8 month

Comes to sit, crawls

Inspects objects “Dada” indiscriminately Fingerfeeds

9 month

Pivots when sitting, pulls to stand, cruises

Uses pincer grasp, probes with forefinger, holds bottle, throws objects

“Mama” indiscriminately, gestures, waves bye-bye, inhibits to “no”

Starts to explore environment; plays gesture games (e.g., pat-a-cake)

10 month

Walks when led with both hands held

“Dada/mama” discriminately; orients to bell (directly)

11 month

Walks when led with one hand held

One word other than dada/mama, follows 1-step command with gesture

12 Walks alone Uses mature pincer grasp, Uses two words other Imitates actions, comes

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month releases voluntarily, marks paper with pencil

than “dada/mama,” immature jargoning (runs several unintelligible syllables together)

when called, cooperates with dressing

13 month

Uses three words

14 month

Follows 1-step command without gesture

15 month

Creeps up stairs, walks backwards

Scribbles in imitation, builds tower of 2 blocks in imitation

Uses 4 to 6 words 15 to 18 mo: uses spoon, uses cup independently

17 month

Uses 7 to 20 words, points to 5 body parts, uses mature jargoning (includes intelligible words in jargoning)

18 month

Runs, throws objects from standing without falling

Scribbles spontaneously, builds tower of 3 blocks, turns 2 to 3 pages at a time

Uses 2-word combinations

Copies parent in tasks (sweeping, dusting), plays in company of other children

19 month

Knows 8 body parts

21 month

Squats in play, goes up steps

Builds tower of 5 blocks Uses 50 words, 2-word sentences

Asks to have food and to go to toilet

24 month

Walks up and down steps without help

Imitates stroke with pencil, builds tower of 7 blocks, turns pages one at a time, removes shoes, pants, etc.

Uses pronouns (I, you, me) inappropriately, follows 2-step commands

Parallel play

30 month

Jumps with both feet off floor, throws ball overhand

Holds pencil in adult fashion, performs horizontal and vertical strokes, unbuttons

Uses pronouns appropriately, understands concept of 1, repeats 2 digits forward

Tells first and last names when asked; gets self drink without help

3 year Can alternate feet when going up steps, pedals tricycle

Copies a circle, undresses completely, dresses partially, dries hands if reminded

Uses minimum 250 words, 3-word sentences; uses plurals, past tense; knows all pronouns; understands concept of 2

Group play, shares toys, takes turns, plays well with others, knows full name, age, sex

4 year Hops, skips, alternates feet going down steps

Copies a square, buttons clothing, dresses self completely, catches ball

Knows colors, says song or poem from memory, asks questions

Tells tall tales, plays cooperatively with a group of children

5 year Skips alternating feet, jumps over low obstacles

Copies triangle, ties shoes, spreads with knife

Prints first name, asks what a word means

Plays competitive games, abides by rules, likes to help in household tasks

Growth and Development

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